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Long state Medicaid benefit processing delays prompt lawsuit

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Illinois

* Sargent Shriver National Center on Poverty Law…

Attorneys on behalf of thousands of low-income people filed a motion in court on Wednesday to enforce federal law and the State of Illinois’ agreement to process Medicaid applications in a timely fashion. The attorneys charge that the State is violating both federal law and an Illinois court order by significantly delaying Medicaid applications and denying residents access to health coverage.

The motion, filed in U.S. District Court in Chicago, asks the court to enforce an existing consent decree that requires the State to determine eligibility for Medicaid within federal timelines, and to offer temporary medical assistance to people whose applications nonetheless pend beyond the federal time limits. The advocates allege the State is woefully behind on its processing and has not offered temporary medical assistance as a solution.

“I have represented a multitude of youth clients experiencing homelessness, many of whom have significant physical and mental healthcare needs, who are going without access to care for months,” said Tanya Gassenheimer, Youth Health Attorney at the Chicago Coalition for the Homeless. Gassenheimer, who helps youth experiencing homelessness apply for Medicaid and file appeals with DHS regarding any issues with those applications, filed a declaration in the motion. “My clients rely on programs like Medicaid for survival. These issues are simply inexcusable and it’s well past time for DHS to act.”

Under federal law, the State of Illinois is required to process most applications for Medicaid—the federal-state program that provides health coverage to roughly 3 million Illinoisans—within 45 days. Pursuant to the existing consent decree in Cohen v. Wright, if a determination has not been made in that period, the State must notify applicants that they are eligible for temporary coverage and promptly provide it if requested.

Yet as detailed in declarations filed by enrollment assisters and healthcare providers, the Illinois Department of Human Services (DHS) is months behind in processing applications and has also stopped sending notices offering temporary eligibility. As a result, tens of thousands of low-income people throughout Illinois are being denied medical care. Among the widespread suffering and hardship, pregnant women are giving birth without health coverage, people facing mental health crises are missing treatment, and children with serious medical conditions are forgoing crucial medication. […]

Plaintiffs allege that delays in processing Medicaid applications have worsened in the last several months, and that eligible individuals are routinely waiting for three to six months to have their applications processed and approved. The lawsuit comes after lawyers representing the plaintiffs tried for months to resolve the issues without legal action, but were unable to compel DHS to comply.

* From the motion…

On average since June 2016, DHS has admitted that it is responsible for the delay more than 98% of the time.

posted by Rich Miller
Wednesday, May 16, 18 @ 2:59 pm

Comments

Another one of Rauner’s “money saving” policies that us going to cost the State taxpayers big time?

Comment by RNUG Wednesday, May 16, 18 @ 3:05 pm
The foolhardy implementation of IES phase II and the decimation of the DHS workforce ( I’ve moved up in seniority so fast in three years from senior caseworkers leaving that I get to take Thanksgiving vacation this year. A decade ahead of when I thought. So many have left)

Have been brutal for our customers
IES has created years of work and problems
Rauners hatred of stateworkers has doubled our workload because so few of us are left.

So glad this suit happened

Comment by Honeybear Wednesday, May 16, 18 @ 3:17 pm
Significant factors being 1. IES, subject to frequent problems, not user friendly and despised by casework staff and supervisors alike, 2. Task based casework management; this under-publicized aspect is largely responsible for delays in approving and maintaining long term care and assisted living cases and 3. insufficient numbers of experienced casework staff. IES needs to go.

Comment by kitty Wednesday, May 16, 18 @ 3:18 pm
-kitty- For what it’s worth, when the system was procured (in 2013), it was fully known that it would be task-based, and that was likely considered a “good” thing. Also, the delays for phase 2 go back at least 3 years. A quick google search reveals some interesting tidbits, like these meeting minutes (https://www.illinois.gov/hfs/SiteCollectionDocuments/101914_macpubed_minutes.pdf) from 10/9/14 that have the initial Phase 2 go-live date being pegged for September of 2015. These problems go back a long ways.

Comment by Tasks Wednesday, May 16, 18 @ 3:31 pm
This lawsuit is long overdue.

Comment by Flynn's Mom Wednesday, May 16, 18 @ 4:32 pm
It’s interesting it’s taken this long. The depar5ment stopped sending out notices June 2016, and they file suit almost 2 years later? And June 2016 is before IES phase II. That happened in October 2017, which is coincidentally when the Cohen reports stopped. What a mess.

Comment by Perrid Wednesday, May 16, 18 @ 8:18 pm
From way back in November of 2013, Deloitte system architects were overheard saying that they expected that about 75% of senior caseworkers get so frustrated with the new IES System that they would either retire or quit, allowing for the hire of new (cheaper) caseworkers.

It’s not a bug, it’s a feature.

Comment by Me Again Wednesday, May 16, 18 @ 11:43 pm
The RFP to contract out case processing is being written. The lawsuit will only help to justify the privatization.

Comment by Bug Thursday, May 17, 18 @ 9:06 am